MEDICARE: MICHEALA ROSE KEEHN LAC, EAMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	60720497	WA

General Provider Information

NPI Number	:	1508306929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHEALA ROSE KEEHN LAC, EAMP

Provider Business Mailing Address
First Line	:	7422 E GREEN LAKE DR N
Second Line	:	APT3
City	:	SEATTLE
State	:	WA
Zip	:	98115-5382
Country	:	US
Telephone Number	:	206-900-4884
Fax Number	:

Provider Business Practice Location Address
First Line	:	7422 E GREEN LAKE DR N
Second Line	:	APT3
City	:	SEATTLE
State	:	WA
Zip	:	98115-5382
Country	:	US
Telephone Number	:	206-900-4884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2017
Last Update Date	:	03/03/2017

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